![]() Typically with isolated posterior OMI - ST depression will be maximal between leads V2-to-V4.Limb lead findings in ECG #1 are strongly suggestive of acute high-lateral OMI.The shape of this ST-T wave depression indicative of posterior OMI is often quite distinctive - in that its mirror-image "looks like" an acute STEMI. Smith and Meyers have emphasized on many occasions - ST depression that is maximal between leads V2-to-V4 in a patient with new chest pain should be assumed to be posterior OMI until proven otherwise. ( I've added LINKS to a series of other cases in this September 21, 2022 post that illustrate the utility of the Mirror Test ). This is simply a visual aid that I've used for decades to facilitate recognition of acute posterior OMI. I've called application of this principle the " Mirror Test".As a result - the mirror-image of anterior chest leads provides a more readily visible picture of ongoing ST-T wave deviations in the posterior wall of the left ventricle. In contrast to posterior leads - the amplitude of ST-T wave deviations that is seen in anterior chest leads is not attenuated by the thick musculature of the back before being recorded on the ECG.This may be beneficial if it serves to convince an interventionist who otherwise was not going to cath the patient. That said - sometimes there will be ST elevation in posterior leads. ![]() ![]() Smith's ECG Blog - as per My Comment at the bottom of the page in the September 21, 2022 post) - QRST amplitudes ( and therefore the amount of ST-T wave elevation ) in posterior leads is often modest at best - simply because posterior placement of leads V7,V8,V9 situates these leads in a position from which electrical activity must pass through the thick musculature of the back before being recorded on the ECG. ![]()
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